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surgery at Boston's Peter Bent Brigham Hospital (now Brigham and Women's). Moore was horrified by the possibility that Wennberg's work might have some impact in the political arena: "Both of the articles in question have recently been quoted in Washington hearings by the Kennedy Committee and the Moss Committee," he wrote in a 1977 letter to the editor of the Maine journal. "They have been used to prove that it is the capricious whim and fiscalmotivation of surgeons that dictates the level of surgical care in the community, rather than the needs of the populations. It is unfortunate that these studies . . . with such glaring deficiencies—were published at all, and especially unfortunate that they now provide some additional basis for medical legislation of a national character."

Wennberg's response was temperate, though he and his coauthor allowed themselves a trace of irony in the last sentence of their rebuttal. They began by pointing out that "the phrase 'capricious whims of hospitals, physicians and surgeons' is strictly Dr. Moore's, never having been employed by either of us." Following a point-by-point refutation of Moore's objections to their findings, they concluded: "We have attempted to ensure that the data are correct within the limits imposed by the medical record and other data systems available to us. It has been our objective to let the data tell their own story. We feel gratified that our work has received national attention and regret that Dr. Moore finds the situation 'especially unfortunate.'"

Thirty years later, not only is Wennberg's work widely recognized in Washington, D. C., but it is helping to shape the national discussion about health-care reform. Political leaders such as presidential candidate Hillary Rodham Clinton and Glenn Hackbarth—the chair of the Medicare Payment Advisory Commission (MedPac), the independent commission that advises Congress on Medicare spending—frequently quote what has

Eventually Wennberg made converts. With him here, in 1989, are two—Maine surgeon Bob Keller (left) and Hal Sox (right), then chair of medicine at DMS.

Wennberg's interest in social change translated into a fascination with epidemi- ology, the root causes of illness, and the health of the health-care system itself. "I was interested in measuring process, structure, and outcomes," he explains.

become known simply as "the Dartmouth research."

The national press, too, makes regular and laudatory mention of "the Dartmouth research." A major editorial a month ago in the New York Times on "The High Cost of Health Care," for example, cited "pioneering studies by researchers at Dartmouth [that] have shown enormous disparities in expenditures on health care from one region to another with no discernible difference in health outcomes." (For more on the impact Wennberg's work has had on national health policy, see "The State of the Nation's Health" in the Spring 2007 issue of Dartmouth Medicine.)

What is even more impressive is that in the blogosphere, where much of the cutting-edge debate about health-care reform takes place nowadays,

Wennberg's name is not just widely known but universally respected. Matthew Holt, editor of The Health Care Blog, says of Wennberg that "while it takes 17 years for medical research to become part of everyday practice, it's taken more than double that time for the work of Jack Wennberg and his colleagues at Dartmouth to permeate the national consciousness and become a staple in the New York Times. But much like another seismic debate of our time, global warming, it's become impossible to argue with Jack on the evidence—even though his findings are tilting at a $2-trillion* industry with good reason to ignore them. And while there may not be a Nobel Prize for economics in the offing for Jack, to paraphrase a great economist who didn't win one either, he is the defunct health services researcher to whom all practical men setting health policy in the future will be slaves." Holt's comment is a reference to a famous observation by John Maynard Keynes that practical men "are usually the slaves of some defunct economist."

Practicality, in fact, has always been Wennberg's goal: he wanted to affect how medicine is practiced. "He wasn't just committed to solving an intellectual puzzle," says Dr. Albert Mulley, chief of general medicine at Massachusetts General Hospital and a 1970 graduate of Dartmouth College. "He was willing to take the risk of trying to make the solution to that puzzle practical," Mulley goes on. "That is not generally what academics do. But he wanted to solve it so that he could make the world a better place. From the perspective of an academic medical center's reward system, this involved some risk."

Recruited by Dartmouth
Throughout the 1970s, Wennberg continued his labors in relative obscurity. "He is one of the most tenacious individuals I've ever known—almost to the point of being pig-headed," says his longtime friend Jim Strickler. "And then it turns out that he's right. That combination annoys people."

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